Healthcare Provider Details

I. General information

NPI: 1982808705
Provider Name (Legal Business Name): HILDALE TOWN CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTH 350 EAST
HILDALE UT
84784-1588
US

IV. Provider business mailing address

PO BOX 841588
HILDALE UT
84784-1588
US

V. Phone/Fax

Practice location:
  • Phone: 435-874-2400
  • Fax: 435-874-2753
Mailing address:
  • Phone: 435-874-2400
  • Fax: 435-874-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2720L
License Number StateUT

VIII. Authorized Official

Name: GLEN JEFFS
Title or Position: MANAGER
Credential:
Phone: 435-874-2400